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Dysphagia

What is dysphagia?

When something goes wrong with the muscles that direct swallowing, it’s called dysphagia.

Dysphagia can lead to food or other material entering the airways or lungs. This is called aspiration. Normally, a flap called the epiglottis blocks food particles and stomach contents from entering your lungs. Dysphagia can disrupt this process. Aspiration is serious because it can lead to pneumonia and other problems.

Problems with any of the phases of swallowing can cause dysphagia.

You normally swallow hundreds of times a day without even thinking about it. You swallow foods, liquids, and the normal saliva and mucus that your body makes.

When you swallow food, it passes through your mouth and into a part of your throat called the pharynx. From here, the food passes through a long tube (esophagus) before entering your stomach and the rest of your gastrointestinal tract. This requires a series of actions from the muscles along the path. It also requires coordination with the muscles of breathing. Breathing pauses when you swallow.

Swallowing is a very complex process. It requires the coordination of several nerves and muscle groups. Doctors describe it in three phases:

Oral preparatory phase. During this phase, you chew your food to a size, shape, and consistency that can be swallowed. This is called a bolus. The arch of your mouth and your tongue connect to prevent food or liquid entering the pharynx. Then, your tongue rises, squeezing the bolus back along the roof of your mouth and into your upper pharynx. You have some conscious control over these actions.

Pharyngeal phase. Here, the muscles of your pharynx contract in sequence. This moves the bolus down toward the esophagus. At the same time, the esophageal sphincter relaxes. This is a tight ring of muscles at the entrance to the esophagus. This lets the bolus to enter the esophagus.

Esophageal phase. The muscles in your esophagus contract in sequence to move the bolus toward your stomach. The lower esophageal sphincter also relaxes. This is a tight ring of muscles at the bottom of the esophagus. This lets the bolus enter the stomach.

The last two phases are not under conscious control.

What causes dysphagia?

Several conditions can lead to swallowing problems. Some examples are:

Stroke

Dementia

Head and neck cancer

Head injury

Conditions that lead to less saliva such as Sjogren syndrome

Parkinson or other nervous system conditions

Muscular dystrophies

Blockage in the esophagus such as from cancer or a history of intubation

Motor problems of the esophagus

Trouble with different phases of swallowing may mean different sorts of medical problems. For example, decreased saliva is likely to cause a problem with the oral preparatory phase of swallowing. Parkinson disease might cause problems with the pharyngeal phase. A blockage in the esophagus would likely cause problems with the esophageal phase.

What are the symptoms of dysphagia?

Dysphagia and aspiration might cause some of the following symptoms:

Sense of food sticking in your throat or coming back into your mouth

Pain when swallowing

Trouble starting a swallow

Coughing or wheezing during or after

Excess saliva

Feeling congested after eating or drinking

Having a “wet” sounding voice during or after eating or drinking

Shortness of breath or fatigue while eating

Repeated bouts of pneumonia

Your symptoms may partly depend on the phase of your swallow that is affected.

How is dysphagia diagnosed?

If you have symptoms of dysphagia or aspiration, you need to be checked right away. If you have a condition, such as stroke, that can cause trouble swallowing, you will need to be evaluated for dysphagia.

Diagnosis usually starts with a health history and evaluation. This is often done by a speech-language pathologist (SLP). The SLP may start by asking you about symptoms that might be related to dysphagia. He or she usually asks questions about the kinds of things that give you problems and about the timing of your symptoms.

The SLP will also look at your teeth, lips, jaws, tongue, and cheeks. You may need to move these areas in certain ways and make certain sounds. Your SLP may also check how you swallow different consistencies of liquids and foods. All of this is to help determine what phase of swallowing might be causing your problems. It can also give clues about the underlying cause for your dysphagia.

In some cases, you might need follow-up testing to find the source of your dysphagia. These tests can also help find the phase of swallowing that is causing the problems. These might include:

Modified barium swallow test (MBS) to show if material is traveling into your lungs

Fiberoptic endoscopic evaluation of swallowing (FEES) instead of MBS

Pharyngeal manometry if the origin of the dysphagia is still in question, to check the pressure inside your esophagus

How is dysphagia treated?

If possible, your medical team tries to address the underlying cause of dysphagia. In certain cases, you may need surgery to treat the root cause. You also may be able to take medicines to reduce the flow of saliva to address a cause of your dysphagia.

The symptoms of dysphagia also need to be managed. Depending on the specific type of your dysphagia, this might include:

Changing your diet. This might mean using thickening liquids or having no liquids at all.